Hysterectomy and Vaginectomy Information
This is part 3 in a series of posts summarizing what was said during the Gender Odyssey conference in Seattle from August 14-17, 2014. This is a mix of basic and supplemental knowledge. This is knowledge to expand upon what you already know but may not provide groundwork for fully understanding it otherwise.
Dr. Webb – Scottsdale, Arizona. Co-surgeon of Dr. Meltzer
Dr. Nicole – Burlingame, California. Co-surgeon of Dr. Bowers
Dr. Crane - San Francisco, California (mentioned)
There are 3 main forms of hysterectomy operations available and what you choose will impact the price, risks involved, and recovery time you will experience:
Total Abdominal Hysterectomy (TAH) – An incision is made across the abdominal wall, cutting through skin and connective tissue. Longest healing time, most pain, leaves a 5 inch scar on the abdomen. 6 weeks to return to normal activity levels.
Vaginal Hysterectomy – An incision is made at the top of the vagina. Faster healing time than the TAH, but it’s like operating through a long, narrow tube, so surgeons can’t view your other organs. Less pain than TAH, faster recovery, but you’ll bleed out of that area for a little while. 2 weeks to return to normal activity levels, with restrictions placed on heavy lifting.
Laparoscopic Hysterectomy – Small incisions are made in the abdomen (1/4th of an inch or so) and laparoscopic tools are used. This gives the surgeon a full view of the abdomen. This is usually the cheapest method, is minimally invasive, and has the fastest recovery time. This is the operation I would opt for, personally. 6 days-2 weeks to turn to normal activity levels, with restrictions on heavy lifting.
The prices of these operations vary, but Dr. Nicole listed the prices of her and Dr. Bowers as (and this includes hospital fees):
$13,000 – Laparoscopic with Dr. Nicole
$17,000 – Abdominal or vaginal with Dr. Bowers
Dr. Webb mentioned something that I can’t verify. He talked about how doctors will leave pieces behind sometimes when performing hysterectomies, sometimes even a full ovary, and that when he performs a vaginectomy he always checks to make sure everything has been properly removed. I don’t know whether or not to believe him, but with the way he spoke about it I feel the need to. I’m torn about this.
There is no real medical benefit for having a hysterectomy performed. There have been no proven instances of testosterone therapy in transgender men increasing rates of cancer in our reproductive organs (cervical, ovarian, etc.). In the Hormones 101 workshop it was even discussed that a recent study might suggest that testosterone prevents ovarian cancer, but this was measured in cis women taking small doses. At this time no long term studies have been performed specifically assessing whether or not testosterone increases rates of cancer in our reproductive organs, but anecdotal information from doctors and surgeons with 15+ years of experience treating trans populations suggests that there is no link. I’m inclined to believe this. There are two main reasons a person will opt for a hysterectomy:
1) They have no desire to have these parts inside of them as they were never meant to have them
2) Pain. Dr. Nicole explained that on testosterone the uterus becomes small. As it shrinks down it pulls on the surrounding muscles, specifically the round ligaments, which can cause cramping/contractions which can be very painful. I’ve experienced this myself and it’s fairly common.
Trying to get a hysterectomy done when you are young is quite a pain but it isn’t impossible. This is because it is voluntary sterilization and there is a dark history around the sterilization of populations and a lot of stigma associated with that. Most places want you to be at least 21, but getting them under this age (or underage in general) is not impossible.
- If you have a vaginectomy you absolutely need to have a hysterectomy.
- You can have a vaginectomy done without having any form of bottom surgery.
- You can have urethral lengthening done without needing a vaginectomy. Dr. Crane and Dr. Bowers allow this, but Dr. Meltzer requires one to be performed if UL happens. This is because leaving the vagina increases the complication rates associated with UL.
The urethra runs along the top of the vagina. When performing urethral lengthening the original urethra needs to have an extension placed at the end of it at a 90 degree angle so that it can be rerouted to allow you to pee from the newly positioned opening. This is a lot of work going on in a small area, so if you don’t have a vaginectomy done then they need to both maintain the vagina while supporting this very delicate urethral lengthening process, which is where the complications come in. Mucosa is what supplies blood flow to the urethra and proper blood flow is necessary for healing to occur, so when the blood flow is limited then complications arise and the urethra can fail. If you perform a vaginectomy and sew the walls of the vagina shut, then blood vessels from both sides of the vagina will supply more blood to the urethra and lower the rate of complications. Sewing these walls shut also provides support for the bowels and the bladder so that they stay in place as you age.
Dr. Crane described complication rates associated with UL and a vaginectomy at about 10-20%, whereas without a vaginectomy complication rates increase to at least 25%. These estimates seemed a little conservative based on what I’ve heard, but I’ll leave it at that.